Provider Demographics
NPI:1457634404
Name:NGUYEN, THU KIM THI (OD)
Entity Type:Individual
Prefix:
First Name:THU
Middle Name:KIM THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9516 MIRAMAR RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4533
Mailing Address - Country:US
Mailing Address - Phone:510-541-4760
Mailing Address - Fax:858-271-0853
Practice Address - Street 1:9516 MIRAMAR RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4533
Practice Address - Country:US
Practice Address - Phone:858-566-4110
Practice Address - Fax:858-527-1085
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist